International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438 Volume 4 Issue 1, January 2015 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Role of Rush Nail in Fracture Forearm Bones with or Without Bone Graft Dr. Kanwarjit Singh Sandhu 1 , Dr. Girish Sahni 2 1,2 Assistant Professor, Department of Orthopedics, Government Medical College, Patiala, Punjab, India Abstract: Background : Rush nail is a very handy, low cost easily available implant. In the present study, we have tried to find out its applicability in fracture of both bones with ORIF with or without Bone graft. The objectives were to evaluate the results of intramedullary fixation of fractures of both bone forearm in terms of fracture union, range of movement complications and functional outcome. Materials and Methods : This study was conducted on 60 adult subjects. Skeletally mature subjects with Gustilo Type 1 open and closed subjects were included in the study while the subjects having Gustilo Type 2 & 3 open, with neurovascular deficit were excluded from the study. Stainless steel rush nails were used for all the patients for both radius and ulnar repair through conventional surgical approach to radius and ulna. In fractures older than ten days autogenous cancellous graft was used. Follow-up was done at 6, 12 weeks & till fracture union postoperatively. Results : Mean Age of the study was 36.2 years & mean time of union was 14.8 weeks. No intra-operative complication occurred, there was no case with nonunion of both bones, Hardware failure was noted in 4 cases, 2 cases developed ulnar non union, in one case due to physical activity ulnar nail bent and only one nail had protrusion of ulnar nail. Only 3 patients developed superficial stitch abscess which improved with antibiotics and none had deep infection. Using Andreson criteria results were evaluated and 48 patients (80%) had satisfactory to excellent results. Conclusion : Use of rush nails continues to have predictable and good results, complication results are lower when compared to plate osteosynthesis although application of above elbow cast after nailing is a downside of this procedure. Open reduction and fixation with rush nail still has a prospect in repair of forearm fractures considering its low complication rates, cost and acceptable results in a developing country like India where financial matters and non availability of C-arm image intensifier are to be considered. Keywords: Facture both bone forearm, open reduction, rush nail, bone graft, management in a developing country 1. Introduction Forearm skeleton in humans is adapted more for mobility than stability and plays an important role in upper extremity function. The presence of proximal and distal radio-ulnar joints allow pronation and supination movements. Moreover, forearm serves as the origin of muscles inserting on the hand, therefore fracture of forearm bones significantly affect a function of whole upper limb. A developing country like India cannot afford the luxury of providing expensive surgical treatment to general public majority of which is still below poverty line. Often, traditional methods of closed reduction are followed to treat the patients of forearm fractures. Closed reduction and immobilization often shows good results in case of children as normal function of the affected limb can be restored due to remodeling, however the scenario is totally changed when fractures of the adults are treated. Diaphyseal fractures of the radius and the ulna present specific problems in addition to problems common to all fractures of shafts of long bones. In addition to regaining length, apposition, axial alignment achieving normal rotational alignment is necessary for restoration of good range of pronation and supination movement. [1],[2],[3] The chances of malunion and non union are greater because of the difficulty of reducing and maintaining reduction of two parallel bones in the presence of pronating and supinating muscles, which have angulatory as well as rotatry elements. Open reduction and internal fixation has many advantages over closed reduction in adults. ORIF has 3 fold aim; firstly to obtain more satisfactory reduction; secondly to improve the possibility of bone union; thirdly to achieve rigid fixation. With the unacceptable results of closed methods and with the less than excellent results of a variety of intramedullary appliances, numerous investigators sought more rigid fixation by means of plates and screws. [4],[5],[6] Hidka and Gustilo [7] disfavored plating because of various drawbacks:- long duration of operation, long exposure and striping of more soft tissue, unsuitable for extreme one- fourth of bones, unsuitable for long, oblique, spiral or severely comminuted fractures, difficulty in removing plates and re-fracture after their removal. Intramedullary nailing has distinct advantages over the above mentioned disadvantages of plates. It is comparatively easier to use and causes minimal damage to the soft tissue at the fracture site, more cost effective and require less costly armamentarium and expertise. Rush nail can be used in the closed manner under C-arm control without injuring soft tissues and preserving the periosteal vascularity But in developing countries like ours where financial problem restrict the options Open reduction and internal fixation with rush nail could be handy in the both bone fractures of forearm. In the present study, we have tried to find out its applicability in fractures of both bone forearm. The objectives were to evaluate the results of closed intramedullary fixation of fractures of both bone forearm in terms of fracture union, range of movement complications and functional outcome. 2. Materials and Methods This case series prospective study was conducted on 60 adult subjects of fracture both bones forearm treated by open reduction and internal fixation with Rush nail, attending Orthopedic department of Rajindra hospital after getting clearance from the institutional ethics committee. Written Paper ID: SUB15228 678